Lipiodol chemoembolization for colorectal cancer: An in vivo animal study and a preliminary clinical study

Introduction: Colorectal cancer (CRC) is the third most common cancer worldwide. Objective: This study aims to investigate the safety and effectiveness of Lipiodol chemoembolization (LCE) of the colorectal artery in an in vivo animal study and a retrospective clinical study in patients with advanced CRC. Methods: The in vivo study was conducted on six Large White pigs undergoing LCE of the posterior mesenteric artery. Lipiodol distribution in the colorectal tract was observed using computed tomography. Colonoscopy and pathological examinations were used to evaluate mucosal reactions. For the preliminary clinical study, 12 patients with advanced CRC received LCE. Subsequently, procedure-related complications, adverse reactions, and tumor changes after iodized oil embolization were observed. Results: Following chemoembolization, no severe complications (e.g., necrosis, perforation) were observed in pigs. Acute colorectal edema detected on post-operative day 1 resolved progressively, with complete clearance of Lipiodol by day 14. Pathological manifestations included mucosal and submucosal infiltration of neutrophils, lymphocytes, macrophages, and other inflammatory cells, focal mild erythrocyte extravasation, local mucosal erosion, and superficial ulceration—all of which resolved completely on follow-up. No peri-procedural severe adverse events occurred in patients. Transient mild abdominal pain, mucinous discharge, and tenesmus were common but improved rapidly. The overall disease control rate and objective response rate were 91.6% and 83.3%, respectively. Disease stage and post-treatment systemic therapy were significant predictors of overall survival (OS). The median OS was 16.0 months (95% confidence interval: 14.51–25.65). Conclusion: LCE of the colorectal artery appears to be technically feasible and safe. It may be considered a potential novel treatment option for patients with advanced CRC.